- Enrollment id
- O20050112000300
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1295788289
- Multiple npi flag
- N
- Ccn
- 457907
- Associate id
- 6103874557
- Organization name
- AMERICAN MEDICAL HOME HEALTH SERVICES - SAN ANTONIO LLC
- Organization type structure
- OTHER
- Organization other type text
- SINGLE-MEMBER LLC
- Proprietary nonprofit
- P
- Address line 1
- 5805 CALLAGHAN RD
- Address line 2
- STE 300
- City
- SAN ANTONIO
- State
- TX
- Zip code
- 782281127